CMSC-ACTRIMS: Postpartum Steroid Reduces Relapses

Action Points

Tell interested patients that some preliminary evidence suggests that a single dose of the steroid methylprednisolone given immediately after a woman with MS gives birth may reduce the relapse rate for up to three months.

Note that the small sample size and retrospective nature of the study limit its generalizability.

Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

SAN ANTONIO -- A single dose of methylprednisolone given to new mothers with multiple sclerosis immediately after delivery reduced the risk of relapse for up to three months, researchers found.

During the first postpartum trimester, relapses occurred in 18% of new mothers who received 1 g of intravenous methylprednisolone compared with 46% of those not receiving treatment (P=0.0448), according to data presented here at the meeting of the Joint Consortium of Multiple Sclerosis Centers and America's Committee on Treatment and Research in Multiple Sclerosis.

In the following six months, there was no difference in the relapse rates between the two groups, Jose Avila, MD, of the Maxine Mesinger MS Comprehensive Clinic at Baylor College of Medicine in Houston, reported.

Preliminary work from other centers has suggested that IV methylprednisolone might be effective in reducing the relapse rate after birth. Avila's group had been using this treatment in many new mothers at their clinic and so performed a retrospective analysis of their outcomes to further understand its potential.

The researchers examined 50 patients with relapsing-remitting MS and two with primary progressive disease. Of those, 39 had received steroid treatment immediately after giving birth, and 13 had not. The mean ages of the women were the same in each group, as was the mean disability score. Both groups had similar relapse rates in the year before pregnancy, and each group contained one patient with the primary progressive form of the disease.

The results of the trial suggest that IV methylprednisolone immediately postpartum may be an important treatment option for women with MS, Avila said, although larger and prospective trials are needed first.

He also indicated that a second dose of methylprednisolone may be worth investigating, to determine if it can reduce relapse rate later into the postpartum period.

Prior research has demonstrated that relapse rates rise immediately following delivery. An alternative treatment, intravenous immunoglobulin, is significantly more expensive and more complex to administer than IV methylprednisolone.

"It was not actually expected that there would be such a difference between the two groups, but it is compelling to think that it could be somewhat preventative," said Kathleen Costello, MS, MSCN, of the Johns Hopkins Multiple Sclerosis Center. "Although data support that long-term outcomes are equal whether you have a relapse in the postpartum period or not, a relapse is the last thing a new mother is going to need in the first 12 weeks after delivery. So if this is a safe method of reducing that risk, I think it is a good idea. We'll need more data and replication, but I think it is very compelling."

Limitations of the study include its small sample size and retrospective nature, so caution should be exercised when considering the likely efficacy of this approach in other patients.

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